When I was in my specialty psychiatry training in the 1970s and starting my psychiatric career in the 1980s, Irvin Yalom, M.D., was the psychiatrist leader who taught us so much about group psychotherapy. His son, Victor Yalom, Ph.D. has among many things, spent the past three decades making training videos of master therapists through the company he inadvertently created, Psychotherapy.net.
I invited Victor to share a little of this first volume for this issue of Tips and Topics. All the content is Victor’s.
Victor gives some SKILLS Tips on how to help clients engage in an internal discover process so they discover new things about themselves. What exactly can therapists do to speed up this process?
Tip 1: Give clients more specific direction in their internal discover process.
Asking “How do you feel?” is a start, but here are some tips to help you help your clients go deeper:
You can start with general questions or prompts such as:
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Take a minute just to check inside and see what you notice.
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As you think about X (whatever client is talking about), do you notice any feelings or sensations?
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Go slow, just turn your attention inward and see if you notice any feelings, thoughts, images, memories... or anything else.
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Sometimes it helps to close your eyes, if you’re comfortable with that.
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Just take a deep breath or two and focus on how that feels.
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What comes to mind as you imagine that? (This may tend to elicit more cognitive responses--that’s ok, we are helping them explore their full range of inner experiences including thoughts).
Then you can support them in continuing their inner “search process” with nudges such as:
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Keep going, see what comes next into your awareness.
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Stay with that feeling of sadness.
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Don’t rush your way through it; give yourself time to sit with it.
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Just stay with that sensation and see what you notice next.
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Just take a minute to check back inside right now and see what else is stirring.
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You've just told me some important things. Now just take a moment to notice what’s happening inside you right now. Again, there could be feelings, images, memories, bodily sensations, thoughts.
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You don’t need to speak in full sentences. Even a word or two can help get the ball rolling. (This can be helpful when clients have a hard time getting started).
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And? (This is simple, and can be powerful, conveying to your clients that there is aways more.)
Tip 2: Pay attention to how clients present themselves versus what they are talking about.
Process comments bring the attention to how clients present themselves versus what they are talking about, and they can be very helpful in assisting clients to tune in to their inner experiences.
This can include bringing attention to:
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facial expressions
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body language
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tone of voice
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implied relationship with therapist, and more.
“Process comments bring the attention to how clients present themselves versus what they are talking about, and they can be very helpful in assisting clients to tune in to their inner experiences.”
Content is the topic being discussed (e.g. relationship or work issues), whereas process is the way in which the client communicates.
Note that we don’t normally make process comments in everyday life, so it may feel awkward or even intrusive at first.
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Try to give yourself permission to try these out, and like anything else, you’ll get better and more at ease over time.
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Practicing with a friend or colleague is a great way to start developing your skills in making process comments.
Process comments can focus on facial expressions:
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I notice you’re smiling as you say that.
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It looks like there’s some sadness (or tenderness) in your eyes.
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You’re holding your head very high, with a little smile on your face.
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You seemed to grimace just there.
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I can see a softness in your face.
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Your face changed a little as you said that.
Or on body language:
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You sort of shrunk down in your seat.
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You’re tightening your fists.
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A big sigh there!
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I notice you keep looking away.
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Your knees are bouncing.
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You’re holding yourself tightly.
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Your breath seems very constricted.
Or on voice:
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Your voice just got very soft.
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You sound angry.
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It sounds like you’re asking a question.
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You keep pausing as you speak.
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You’re telling me about something really awful, but your voice is flat.
Or on implied relationship with the therapist:
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You keep looking to me as if you want my approval.
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You really want me to understand what you’ve gone through.
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You keep interrupting me.
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You’d really like me to tell you what to do.
Tip 3: Be creative and take risks! Use your intuition and creativity to find ways to help clients go deeper.
Here are some ways of helping your clients understand the need to spend some more time exploring their inner world, so that you can assist them. It helps to be open-hearted and spontaneous as well. How can you ask your clients to be present and take risks if you aren’t willing to do the same?
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Try using role-plays to have them talk with different parts of themselves.
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Analogies can be helpful in explaining why they need to focus inward for more than 10 seconds before giving up or looking to you for an answer.
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If your client is a computer programmer, you can say, “If someone asks you to debug a program, but only lets you look at the code for 10 seconds, I imagine you wouldn’t be able to do much.”
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Likewise to a car mechanic, you can say, “If someone brings you their car, but shuts the hood 10 seconds after you’ve opened it, how can you possibly do your job?”
“How can you ask your clients to be present and take risks if you aren't willing to do the same?”
Read the full Volume 22, No. 10 of David Mee-Lee's Tips n Topics here →
More about Victor Yalom here →
Authored by Dr. David Mee-Lee, “Tips & Topics” is a monthly blog covering three sections: Savvy, Skills and Soul, with additional sections varying from month to month. Topics include Stump the Shrink, Success Stories and Shameless Selling.